Description

Factors to drive clinical practice improvement in a Malaysian intensive care unit: Assessment of organisational readiness using a mixed method approach

KIM LAM SOH

Department of Medicine, Faculty of Medicine and Health Sciences, Putra University, Serdang, Selangor, Malaysia; School of Nursing and Midwifery, Curtin Health Innovation Research Institute, Curtin University, Sydney, NSW, Australia

PATRICIA M DAVIDSON

Centre of Cardiovascular and Chronic Care, School of Nursing and Midwifery, University of Technology Sydney and Curtin University, Sydney, NSW, Australia

GAVIN LESLIE

Department Critical Care, School of Nursing and Midwifery, Curtin Health Innovation Research Institute, Curtin University, Perth, WA, Australia

MICHELLE DIGIACOMO

Post Doctoral Research Fellow, Centre for Cardiovascular and Chronic Care, University of Technology Sydney and Curtin University, Sydney, NSW, Australia

JOHN X ROLLEY

Australian Catholic University, Sydney, NSW, Australia KIM GEOK SOH Department of Sport Studies, Faculty of Education, Putra University, Serdang, Selangor, Malaysia

AISAI BIN ABD RAHMAN

Anesthesiology and Intensive Care Department, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Terengganu, Malaysia

ABSTRACT

This study assessed organisational readiness and factors to drive clinical practice improvement for VAP, CRBSI and PU in a Malaysian intensive care unit (ICU). A mixed method study approach was undertaken in a 16-bed ICU in regional Malaysia using an environmental scan, key informant interviews, staff surveys, and patient audit to elucidate factors contributing to planning for clinical practice improvement. Measurements of sustainability of practice and regard for the practice environment were assessed using validated measures. An environmental scan demonstrated high patient occupancy and case load. Nineteen percent of ICU patients developed complications according to validated measures. Survey results indicated that the majority of nurses had a good knowledge of strategies to prevent ICU complications and a positive attitude toward change processes. Engaging executive leadership was identified as crucial in priming the clinical site for practice change. Providing nurses with tools to monitor their clinical practice and empowering them to change practices are important in improving clinical outcomes.

Keywords: clinical practice improvement, intensive care unit, organisational readiness, professional practice environment, mixed methods